Tae Ho Jeong

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

4704408472 Issued in MI

Practice address

4001 W McNichols Rd
Detroit, MI 48221-3038

Phone

(313) 578-0358

NPI assigned

Apr 16, 2026

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1776297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776816000000",
    "number": "1356285688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482213038",
            "telephone_number": "313-578-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482213038",
            "telephone_number": "313-578-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEONG",
        "first_name": "TAE HO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-04-16",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704408472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claire Stewart Jensen, MD
• Jacob Jensen, M.D.
• Jessica Ann Jensen, MSW
• Nicole Marie Jensen, LMSW
• Mackenzie Lee Jenuwine
• Wooju Jeong, M.D.
• Dawn Lasha Jerangan
• Jerel N Owens, DMD, PC
• Jerel Owens D.M.D., P.C.
• Tacarra Jernagin

• Registered Nurse in Detroit, MI
• Providers in Detroit, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.